Provider Demographics
NPI:1245049634
Name:LAKESIDE BABY LLC
Entity type:Organization
Organization Name:LAKESIDE BABY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:JULIANNE
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, IBCLC
Authorized Official - Phone:509-630-1160
Mailing Address - Street 1:PO BOX 501
Mailing Address - Street 2:
Mailing Address - City:CHELAN
Mailing Address - State:WA
Mailing Address - Zip Code:98816-0501
Mailing Address - Country:US
Mailing Address - Phone:509-630-1160
Mailing Address - Fax:509-508-5234
Practice Address - Street 1:2133 W WOODIN AVE UNIT 1
Practice Address - Street 2:
Practice Address - City:CHELAN
Practice Address - State:WA
Practice Address - Zip Code:98816-9309
Practice Address - Country:US
Practice Address - Phone:509-630-1160
Practice Address - Fax:509-508-5234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-31
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty